Leaving a sick feeling

Amy Corderoy, Dan Harrison

Carter Moore had a stomach ache. A trip to the GP and pathology test provided no answers, and later that night the pain became excruciating.

"I was in horrible pain, so I took myself to my local hospital," the former US resident explains. More tests.

A drip, and an overnight stay. The doctors decided it was probably dehydration. "I ended up paying between $450 and $500 all up, just because I was dehydrated," says the policy officer for the Consumers Health Forum of Australia.

In America, co-payments are a way of life – if you are lucky enough have healthcare coverage.

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When the federal government announced it would strip $80 billion over 10 years from education and hospitals, as well as ending bulk-billing for GP visits, many Australians wondered if this was the beginning of the Americanisation of Australian healthcare.

"As an American it definitely made me feel more at home," Moore says. "But I guess there is a difference between coverage and access. Australia has coverage, but is . . . seeing people increasingly having trouble with access."

In NSW about 15 per cent of people put off visits to the GP, filling a prescription and getting medical tests because of out-of-pocket expenses. According to the Council of Australian Governments, nationally the poorest wait 44 per cent longer for recommended surgery than the most well off.

The new changes mean that from July 1 next year, the Medicare rebate for a standard GP consultation will be cut by $5. Doctors will be encouraged to charge $7 more.

Five of these dollars compensate the doctor for the cut, while the extra two are a bonus. Doctors will receive an incentive payment of $6 or $9 in country areas if they charge concessional patients and children only the extra $7.

Doctors are allowed to waive it, but by doing so take a pay cut of more than 25 per cent, because they absorb the rebate cut and the incentive payment. Concessional patients and those under 16 don't have to pay the fee after they have paid it 10 times in a calendar year. Patients who aren't bulk-billed will get $5 less back from Medicare.

Some commentators have suggested many practices which at present bulk-bill may shift to charging the patient a much higher fee upfront.

Dr Lesley Russell, an adjunct associate professor at the Menzies Centre for Health Policy at the University of Sydney, says health inequality in the US has had a high cost, and Australia would do well to learn from America's mistakes. "If you look at where this government is potentially taking us, the ideology that is behind it, it's exactly the opposite to where everybody else in the world is going, including in Asia," she says. Massachusetts, where affordable healthcare was introduced in 2006, has seen 320 fewer deaths each year, or a 2.9 per cent drop in mortality. Among minority groups, there was a 4.6 per cent drop in deaths.

Conversely, extreme austerity measures in Greece have seen cuts to public health spending, with HIV increasing by 200 per cent, and the first malaria outbreak since the 1970s, according to the book The Body Economic, by economist David Stuckler and doctor Sanjay Basu.

The question is, how much inequality makes people sicker? Russell says no one can tell what the effect in Australia will be.

While GP co-payments had been flagged in pre-budget leaks, the states were left gobsmacked by the news that the government would also undo the new structure for funding hospitals set up under Labor (ironically enough, to "end the blame game" between governments).

It is offering up a much smaller piece of the pie than previous Liberal governments, according to Stephen Duckett, health program director at the Grattan Institute.

This week he called the new offer "the most parsimonious funding model since the introduction of Medicare".

The architect of Medicare, Dr John Deeble, agrees.

He says the Commonwealth is "pulling out" of hospitals because "it's a bit hard," and there will not be enough funding for the states to deliver the services the community expects.

But Christine Bennett, AO, who chaired the Rudd government's National Health and Hospitals Reform Commission, is surprisingly upbeat.

"They get a gold star for the medical research future fund," says Bennett, a professor and dean of medicine at the University of Notre Dame.

"It is the most powerful and exciting investment you can make [in health], so it's very exciting." And replacing Medicare locals with Primary Health Networks could actually be "more effective".

Federal Health Minister Peter Dutton says the health system is "world-class" and the budget changes will help it remain so. "The only problem with our world-class system is how long you can afford to pay for it," he said this week.